PMID- 19955244
OWN - NLM
STAT- MEDLINE
DCOM- 20100106
LR  - 20220321
IS  - 1942-5546 (Electronic)
IS  - 0025-6196 (Print)
IS  - 0025-6196 (Linking)
VI  - 84
IP  - 12
DP  - 2009 Dec
TI  - Effect of body mass index on bleeding frequency and activated partial 
      thromboplastin time in weight-based dosing of unfractionated heparin: a 
      retrospective cohort study.
PG  - 1073-8
LID - 10.4065/mcp.2009.0220 [doi]
AB  - OBJECTIVE: To assess bleeding and activated partial thromboplastin time (APTT) in 
      relation to body mass index (BMI) in patients prescribed weight-based dosing of 
      intravenous unfractionated heparin (UFH) for cardiac indications without a 
      maximum (dose-capped) initial bolus or capped initial infusion rate. PATIENTS AND 
      METHODS: Consecutive patients admitted to an academic medical center from 
      February 1, 2002, through November 31, 2003, who were treated with a UFH nomogram 
      consisting of a 60-U/kg intravenous bolus plus an initial continuous intravenous 
      infusion of 12 U/kg hourly and titrated to a goal APTT range corresponding to 
      thromboplastin-adjusted target heparin levels of 0.3 to 0.7 U/mL by anti-Xa assay 
      were evaluated for this retrospective cohort study. Patients were excluded if 
      they concomitantly received a fibrinolytic, glycoprotein IIb/IIIa inhibitor, or 
      any other antithrombotic agent (except warfarin). Study patients were divided 
      into quartiles by BMI. RESULTS: Of the 1054 patients included in the study, 807 
      (76.6%) had an initial bolus dose higher than 4000 U, and 477 (45.3%) had an 
      initial infusion rate higher than 1000 U/h. Despite a significant difference 
      among BMI quartiles in proportion of supratherapeutic first APTT values (P<.001), 
      no statistically significant difference was found in bleeding frequency (P=.26) 
      or frequency of first APTT within the goal range (P=.27). Logistic regression 
      analyses revealed that BMI was not a significant predictor of bleeding or first 
      APTT within the goal range. CONCLUSION: We did not find any difference in the 
      proportion of first APTT values in the goal range or an increased risk of 
      bleeding in obese patients treated with UFH without a capped initial dose. Our 
      data demonstrate the safe use of weight-based UFH without a capped initial bolus 
      dose or capped initial infusion rate in patients with medical cardiac conditions.
FAU - Bauer, Seth R
AU  - Bauer SR
AD  - Department of Pharmacy/JJN1-02, Cleveland Clinic, Cleveland, OH 44195, USA. 
      bauers@ccf.org
FAU - Ou, Narith N
AU  - Ou NN
FAU - Dreesman, Benjamin J
AU  - Dreesman BJ
FAU - Armon, Jeffrey J
AU  - Armon JJ
FAU - Anderson, Jan A
AU  - Anderson JA
FAU - Cha, Stephen S
AU  - Cha SS
FAU - Oyen, Lance J
AU  - Oyen LJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Mayo Clin Proc
JT  - Mayo Clinic proceedings
JID - 0405543
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Body Mass Index
MH  - *Drug Dosage Calculations
MH  - Female
MH  - Hemorrhage/chemically induced/*prevention & control
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Infusions, Intravenous
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Nomograms
MH  - *Obesity
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
PMC - PMC2787393
EDAT- 2009/12/04 06:00
MHDA- 2010/01/07 06:00
PMCR- 2010/06/01
CRDT- 2009/12/04 06:00
PHST- 2009/12/04 06:00 [entrez]
PHST- 2009/12/04 06:00 [pubmed]
PHST- 2010/01/07 06:00 [medline]
PHST- 2010/06/01 00:00 [pmc-release]
AID - S0025-6196(11)60294-2 [pii]
AID - 10.4065/mcp.2009.0220 [doi]
PST - ppublish
SO  - Mayo Clin Proc. 2009 Dec;84(12):1073-8. doi: 10.4065/mcp.2009.0220.